Persistent Right Lower Abdominal Pain: Possible Causes and Next Steps

Intermittent pain in the lower right abdomen for several months?

Hello, doctor.
I have been experiencing intermittent pain in my lower right abdomen since June.
It started on the night of June 10th with sudden severe pain in the lower right abdomen, but it coincided with the fourth day of my menstrual period, so I thought it was menstrual pain and took painkillers (even though I usually only experience menstrual pain on the first and second days).
After that, I had a dull ache in my lower right abdomen, which became more pronounced two weeks later (since June 10th) at the same level as my navel, along with some bloating.
I visited a gastroenterology clinic where I had an ultrasound; the liver, kidneys, gallbladder, pancreas, and spleen showed no abnormalities.
The physician speculated it might be duodenitis or colitis, and after taking the prescribed medication, the pain eased but continued to occur mildly.
Later, I underwent routine stool tests, an upper endoscopy, and a colonoscopy.
The stool test showed no abnormalities, the upper endoscopy revealed superficial gastritis, and the colonoscopy found a 0.2 cm hyperplastic polyp in the rectum.
The physician speculated that the pain was caused by intestinal spasms.
After that, the pain subsided and disappeared, so I did not return for follow-up.
From mid-July to the end of August (August 27), I had no unusual symptoms.
However, starting August 28, I began to feel a foreign body sensation in my lower right abdomen, with tenderness starting from three fingerbreadths below the navel (near the iliac crest) and extending upward along the iliac crest to the right side of the abdomen (approximately at the same height as the navel).
Now, I have pain from the lower right abdomen to the right side of the abdomen, which is more pronounced when fasting.
I would like to ask the doctor what possible issues my body might have.
Could it be related to the reproductive system? I notice that my menstrual pain occurs on the right side every month, which is close to the location of the lower right abdominal pain (the menstrual pain is slightly lower).
Which specialty should I choose for consultation? Thank you for taking the time to read my lengthy description and for responding to my questions.

C.H., 20~29 year old female. Ask Date: 2018/09/02

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Right lower abdominal pain, based on anatomical location, should consider either gynecological conditions or issues related to the colon.
If there are no gynecological problems, then it is likely a gastrointestinal obstruction.
However, gastrointestinal issues are not solely structural; functional disorders can also cause discomfort, such as bloating and abnormal peristalsis.

Reply Date: 2018/09/02

More Info

Persistent right lower abdominal pain can be quite concerning, especially when it has been ongoing for several months with varying intensity and associated symptoms. Based on your description, there are several potential causes for your pain, and it is essential to consider both gastrointestinal and gynecological factors.

Possible Causes
1. Gastrointestinal Issues:
- Irritable Bowel Syndrome (IBS): This condition can cause cramping and pain in the lower abdomen, often associated with changes in bowel habits.

- Diverticulitis: Inflammation or infection of diverticula in the colon can lead to localized pain, often in the lower left abdomen, but can sometimes present on the right side.

- Appendicitis: Although typically presenting with acute pain, chronic appendicitis can sometimes cause intermittent pain in the right lower quadrant.

- Colonic Issues: Conditions like colitis or even benign polyps can lead to discomfort and pain, especially if there is inflammation or spasm in the bowel.

2. Gynecological Factors:
- Ovarian Cysts: These can cause pain, especially if they rupture or become large. The pain may be cyclical and correlate with your menstrual cycle.

- Endometriosis: This condition can cause significant pain in the lower abdomen, often correlating with the menstrual cycle and may cause pain on one side.

- Pelvic Inflammatory Disease (PID): An infection of the reproductive organs can lead to chronic pain and discomfort.

3. Musculoskeletal Issues:
- Sometimes, pain in the abdominal area can be referred from musculoskeletal sources, such as muscle strain or ligamentous pain, especially if you have been active or have had any recent physical activities that could lead to strain.

Diagnostic Steps
Given the complexity of your symptoms, it is crucial to continue working closely with your healthcare provider. Here are some steps you might consider:
- Follow-Up Imaging: If your symptoms persist or worsen, further imaging studies such as a CT scan or MRI may be warranted to evaluate for any structural abnormalities that were not identified on ultrasound.

- Gynecological Evaluation: Since you mentioned that your menstrual pain is often on the right side, consulting with a gynecologist may be beneficial. They can perform a pelvic exam and possibly an ultrasound to rule out any ovarian or uterine issues.

- Gastroenterology Referral: If gastrointestinal symptoms continue, a gastroenterologist can provide further evaluation, including possible endoscopic procedures or advanced imaging.

Managing Anxiety
You also mentioned that you are prone to anxiety, which can exacerbate the perception of pain. Anxiety can lead to muscle tension and increased sensitivity to pain, making it feel more intense. It is essential to address this aspect as well:
- Cognitive Behavioral Therapy (CBT): This can help manage anxiety and its impact on your physical symptoms.

- Mindfulness and Relaxation Techniques: Practices such as yoga, meditation, or deep-breathing exercises can help reduce anxiety and improve your overall well-being.

Conclusion
In summary, your persistent right lower abdominal pain could stem from a variety of causes, including gastrointestinal and gynecological issues. It is essential to maintain open communication with your healthcare providers and consider referrals to specialists as needed. Additionally, addressing any underlying anxiety may help improve your overall experience of pain. Always seek immediate medical attention if you experience severe pain, fever, or any other alarming symptoms.

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